Self-efficacy for diabetes self-management in Latinos: A biopsychosocial approach

Over the last few years much attention has been given to the rising number of people who are being diagnosed as diabetic. Persons of Latino descent, now the largest minority group in the U.S., are nearly two times as likely to develop diabetes than their non-Hispanic White counterparts. Currently there is no cure for diabetes, but it is well known that the disease can be very effectively managed with tight control of blood sugars. The concept of self-efficacy has emerged as an important factor as to how someone manages a chronic illness. Latinos often have more challenges in self-managing their illnesses due to a variety of factors. What are not well documented are culturally appropriate measurement tools and interventions to assess for these challenges. The overall purpose of this study was to explore the influence of self-efficacy and culture on the self-management of diabetes in a sample of Latinos. As there were no existing instruments available to measure the concept of self-efficacy, the DSEL (the Diabetes Self-Efficacy Scale for Latinos) was developed and standardized in a sample of 200 adult Latinos. There were some medium effect size negative correlations between depression and anxiety and global self-efficacy, and between hopelessness and fatalism. Additionally, people with more fatalistic attitudes also had higher levels of hopelessness. The most interesting and unexpected results came from the lack of correlations between the diabetic self-efficacy scores and the medical indicators. Extremely low (near zero) correlations were found between the DSEL subscales and the medical indicators (HbA1c scores, fasting blood glucose, cholesterol level and BMI). Near zero correlations were also found between the medical indicators and the patient scores on the depression, anxiety and hopelessness measures. These very low correlations did not support the study hypotheses, and further research is needed to clarify the relationship between these various factors. Signs of suboptimal health were found even among those whose HbA1c scores were in the desired range, for example, obesity was common and no less severe in those who had optimal HbA1c counts as compared to those with high counts, and some patients known to have blood sugar counts that fluctuated wildly obtained HbA1c counts near the optimal range. HbA1c counts are considered to be the best measures available to the health care professionals at this time, but the results suggested that these indicators might be insufficient as measures of health or of diabetic control. A more holistic approach may be needed to more accurately and adequately measure outcomes in the self-management of diabetes